Dr. Debbie Eisenhut, a Salem-born surgeon, was working in a hospital outside the Liberian capital of Monrovia in March when she heard about the first Ebola cases in the north of the country.

Educated in Oregon with experience in other disaster zones, Eisenhut was stunned: The deadly the virus had never struck West Africa before. She was also worried. She knew it could spread. And if it did, she knew the death toll could skyrocket.

In months, her worst fears played out as the virus marched across Liberia while spreading in Guinea and to Sierra Leone and Nigeria. Eisenhut was swept up into one of the most frightening health crises the world has seen in decades. She also found herself caring for medical missionary Nancy Writebol and Dr. Kent Brantly, the two Americans who contracted the disease but have since recovered after being flown to Atlanta for treatment.

Eisenhut is also now back in the United States taking a much-needed vacation. She plans to visit Oregon next month as she maps out her next adventure. She was not traumatized by her experience but it's unlikely that she will ever forget her time on the front lines, fighting a terrifying disease in the worst Ebola epidemic Africa has ever seen.

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When Eisenhut heard about the first cases in Liberia, she knew she had to protect the staff at the hospital where she had worked as a missionary surgeon for nearly a year. She drilled them on proper hand washing, disinfection techniques and the need to wear protective gear around patients, from hoods, goggles and face masks, to body suits and boots. She warned cashiers not to touch money with their bare hands and helped ensure that everyone was trained, from administrators to janitors.

The hospital, operated by the U.S. missionary organization now known by the acronym SIM, eventually became the only care center for Ebola patients in Liberia as other medical facilities closed with infected staff. The virus also hit her inner circle, sickening Writebol and Brantly.

The epidemic started slowly, then exploded, hitting Liberia hard. The toll in West Africa continued to mount. Last week, the World Health Organization tallied over 2,600 illnesses, more than half of them fatal. Countless others have died at home, under the radar.

"It's unprecedented in the number of patients," Eisenhut said. "This is also the first time that the disease has entered urban areas. It's always been in rural areas before where it's easier to control."

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Eisenhut, 57, arrived in the country in April 2013 on her second, major venture abroad. Born in Salem and raised in Aumsville, she earned her medical degree from the University of Oregon Health Sciences Center, now OHSU. After a residency in Texas, she worked as a surgeon in Salem, first in private practice then at Salem Clinic until 2007, when she decided to become a missionary physician.

On her first assignment, which lasted four years, she traveled to southern Pakistan, where she treated patients under the umbrella of WorldVenture, a U.S.-based Christian missionary group. In 2012, she went to work for SIM, a group that started working in Africa in 1893 as the Soudan Interior Mission.

Her mission in Liberia was to help rebuild SIM's hospital in a suburb of Monrovia. The hospital, known as ELWA for Eternal Love Winning Africa, was once considered a medical jewel in Africa. But it had been all but stripped during years of civil war, which ended in 2003. When Eisenhut arrived, it lacked trained staff and essential supplies. Patients weren't always bathed and didn't get enough food or hydration. There were no hand-washing stations for medical personnel.

Ebola toll

In early August, the World Health Organization designated the outbreak of Ebola Hemorrhagic Fever in West Africa a public health emergency, invoking legal measures to respond to the disease. It kills up to 90 percent of those infected and there is no vaccine.

She trained staff, going on rounds with young doctors, while medical supplies poured in from a dispensary in the Netherlands. Around October, two other Western-trained doctors showed up, including Brantly. His organization, Samaritan's Purse, started building a new hospital across the road to replace ELWA.

Then Ebola struck, with those first cases in Foya, the Liberian city in the north.

"We were very concerned," Eisenhut said. "We started preparing."

One of her colleagues downloaded information from the World Health Organization and the Centers for Disease Control and Prevention on how to cope with an outbreak. The virus spreads through blood and other body fluids and tissue. Patients have to be isolated, and everyone has to follow strict hygiene protocols.

Staff practiced washing their hands while singing the Happy Birthday song, which is just about the right length of time needed for protection. They learned how to make bleach solutions, which kills the virus, and practiced disinfecting gloves. They dug deep pits for waste disposal and designated the chapel as the isolation unit, outfitting it with five beds.

They weren't needed until early June, when the first patient arrived. The chapel was quickly filled, with the physicians working 12-hours shifts, alternating between the regular hospital and the Ebola unit.

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Before entering the chapel, they donned boots, medical hazmat suits with hoods, another hood, goggles, face masks and two sets of gloves that were duct-taped to the suits. With temperatures in the 90s and high humidity, they quickly became drenched.

"I could feel the sweat sloshing inside my gloves," Eisenhut said.

The gear, akin to waddling around in a space suit, made it difficult to give shots or start an IV. Eisenhut couldn't wear her glasses under her goggles because they fogged up. Physicians took to smearing them inside with dish soap – just like scuba divers – to keep them clear.

There is no proven cure for Ebola, which causes miserable symptoms: nausea, vomiting, diarrhea. Some people suffer severe abdominal pain. Others bleed internally.

Physicians kept patients hydrated and as comfortable as possible, giving them pain medication. They bathed patients and prayed with them. When they died, state health officials came in to deal with the body.

"The sicker the patient, the more virus that comes out of their body," Eisenhut said. "The most dangerous time is when a patient dies. Every square inch of the body is covered with the virus."

Health officials sprayed the bodies with a bleach solution, wrapped them, tucked them in a body bag and then disinfected that for burial.

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Soon after the first patients arrived, more beds were needed. Samaritan's Purse built another unit, this one with 20 beds. The group started working on a tent hospital as well for 40 to 60 beds. Officials met with locals, who didn't like the idea. They don't consider Ebola a virus that probably moved from an infected fruit bat to people. They associate it with foreigners, Eisenhut said.

There were riots at the gate and threats of violence. The Liberian national police had to patrol the compound, and at one point the Liberian army confronted a crowd with a tank.

The physicians, who were toiling around the clock, only heard about the unrest. Their biggest concern was fatigue and trying to keep the dozens of patients who cycled through alive. All but two died.

Then Brantly and Writebol got sick, adding to the worry.

"It's difficult to be taking care of your friends," Eisenhut said.

Eisenhut, who had hugged Writebol, had to monitor her temperature twice a day for a fever, the first sign of Ebola. She never got sick.

Writebol and Brantly were released from Emory Hospital in Atlanta last week, both virus-free. The CDC is now investigating to try to determine how they became infected. Writebol did not wear protective gear because she did not have direct contact with patients.

Eisenhut said the situation remains dire in Liberia, though she has hope. Thirteen more patients at the hospital have recovered since she left two weeks ago. She said that in other outbreaks, the virus has become less virulent as it passes through greater numbers of people.

She hopes that happens this time – and soon.

She has no plans to return to Liberia in the immediate future. But she would not hesitate to return under the right conditions.

"I would feel safe going back and caring for patients wearing full protective equipment," Eisenhut said. "Ebola is a dangerous disease. You don't want to be cavalier."